Florida Administrative Code
69 - DEPARTMENT OF FINANCIAL SERVICES
69O - OIR - Insurance Regulation
Chapter 69O-230 - GENERAL ETHICS AND DISCLOSURE REQUIREMENTS
Section 69O-230.033 - Reporting Requirements for Licensees Concerning Unlicensed Insurance Activity

(a) "Agent" means and includes any person holding any type and class of licensure, whether limited or unlimited, issued by the Department under Chapter 626, Florida Statutes. The term also includes any person licensed or registered by the Office as an agent, sales representative, sales agent, salesperson, runner, or bail bondsman, under any of the following statutes: Section 632.634, F.S., (fraternal benefit agents); Section 634.031, F.S., (warranty association sales person); Section 635.051, F.S., (mortgage guaranty insurance agent); Section 641.386, F.S., (health maintenance organization sales agent); Section 642.036, F.S., (legal expense insurance sales representative); or Section 648.30, F.S., (bail bondsman or bail runner). The term includes such persons whether residents of Florida or not.

(b) "Arrangement" means a fund, trust, plan, instrument, program, association, union, or other entity or mechanism, any portion of which does, or purports to, provide for the transfer of the risk of loss, damage, or expense resulting from a fortuitous event, from the person or entity having incurred the loss, damage, or expense, to another.

(c) "Collectively bargained arrangement" means an arrangement (as defined in paragraph (b), hereof), that exists pursuant to one or more bona fide labor agreements, including arrangements that are sponsored by a union or a union local. For purposes of the reporting requirements of this rule, the term also includes arrangements in which both union members and non-members do or may participate. For purposes of this rule, a collectively bargained arrangement does not include an arrangement which is fully insured by a licensed insurer for so long as the arrangement stays fully insured.

(d) "Office" means the Florida Office of Insurance Regulation.

(e) "Employee" means any individual employed by an employer.

(f) "Employee leasing" means a relationship whereby an employee leasing company assigns its employees to a client and allocates the direction of and control over the leased employees between the leasing company and the client. The definition includes, and is subject to the conditions, exclusions and limitations of Chapter 468, Part XI, F.S., and rules promulgated in accordance therewith. Notwithstanding, for as long as an employee leasing company makes available insurance benefits only through licensed insurers, such employee leasing company shall not be a subject of the reporting requirements of this rule.

(g) "Welfare benefit plan" means any plan, fund or program maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund or program was established or is maintained in whole or in part for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, medical, surgical or hospital care or benefits, or benefits in the event of sickness, accident, disability, death or unemployment.

(h) "Employee organization" means any labor union or any organization of any kind, or any agency or employee representation committee, association, group, or plan, in which employees participate and which exists for the purpose, in whole or in part, of dealing with employers concerning an employee benefit plan, or other matters incidental to employment relationships; or any employees' beneficiary association organized for the purpose in whole or in part, of establishing such a plan.

(i) "Employer" means any person acting directly as an employer, or indirectly in the interest of an employer, in relation to an employee benefit plan; and includes a group or association of employers acting for an employer in such capacity.

(j) "Reportable multiple-employer welfare arrangement (MEWA)," for purposes of this rule, means a person that provides or offers insurance benefits or coverage to the employees of two or more employers, whether alone or with other benefits. "Reportable MEWA" does not include:

(k) "Third party administrator" or "TPA" means "administrator" under Section 626.88, F.S., and includes, but is not limited to, all persons licensed by the Office as administrators.

(l) "Unlicensed insurer" is any insurer as defined in Section 624.03, F.S., including self-insurers, which has not been licensed to transact insurance by the Office under the provisions of the Florida Insurance Code; except that any person or group authorized to self-insure for workers' compensation coverage pursuant to Sections 440.38(1), 440.57, and 440.575, F.S., and the rules of the Office is not an "unlicensed insurer" for purposes of this rule. The term includes any plan required to be licensed under the provisions of Chapter 632 or 634-651, F.S.

(m) "Department" means the Florida Department of Financial Services.

(a) Any agent, third party administrator or insurer with knowledge of an unlicensed insurer doing business in the State of Florida, shall report the activities of the unlicensed insurer to the Office and, if known, shall provide the following information:

(b) The report shall be made with the Office at the following address: Attn: Unlicensed Entity Coordinator, Office of Insurance Regulation, Market Regulation. The report can be made by phone, (850)413-3155, or by mail to 200 East Gaines Street, Larson Building, Tallahassee, FL 32399.